Prolonged survival after two-stage resection of advanced colorectal liver metastases: Impact of an intensified chemotherapy.

748 Background: Patients with advanced colorectal liver metastases (CRLM) experience poor prognosis. The impact of two-stage resection (TSR) after downstaging by chemotherapy is still controversial. Methods: Data on 899 patients with CRLM in a single institution during a 9-year period (2004–2013) were prospectively collected. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR associated with intensified chemotherapy before and between the two surgical stages. Results: 73 patients were eligible for the first stage of TSR. In this population, 54 patients underwent an intensified chemotherapy based on FOLFIRINOX (26 patients) or a standard chemotherapy associated with cetuximab or bevacizumab (28 patients). The first surgical stage was a clearance of the left liver in 56% of cases. An average of two radio-frequency ablations and two wedge resections were necessary. The post-operative morbidity of the first stage was 18%. 78% of patients received chemotherapy between the two stages. The average interval between two stages was 228 days (36-1561). 68% of TSR patients completed the second stage. The second resection was mainly a standard right lobectomy (32%). Morbidity after the second resection was 12%. One patient died post-operatively because of post operative liver failure. Median overall survival of patients who completed TSR was 48 months. In contrast, there was no survival advantage for patients who underwent only the first stage because of progression (median overall survival: 19 months) (p = 0.0003). The median overall survival of the whole population was 43 months and the median recurrence-free survival was 15 months. Conclusions: Intensified chemotherapy in association with TSR allows excellent outcome in patients with advanced CRLM. Chemotherapy delivered between the two surgical stages is responsible for an important waiting time but could contribute to a better control of the evolution of the disease.

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Impact of preoperative chemotherapy on overall survival for borderline resectable colorectal liver metastases

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.365 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 365-365

Author(s):

Akio Saiura ◽

Yosuke Inoue ◽

Yoshihiro Mise ◽

Yu Takahashi ◽

Takafumi Ichida ◽

...

Keyword(s):

Overall Survival ◽

Liver Resection ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Controlled Study ◽

Free Survival ◽

Surgical Failure ◽

The Impact

365 Background: Treatment for borderline colorectal liver metastases (CLM) is often started with chemotherapy. However, the impact on overall survival (OS) is still unknown. Aims: The aim of this study is to analyze the impact of preoperative chemotherapy on the outcome for up-front resectable borderline CLMs (BLR-CLM). Methods: A retrospective review was performed of 169 patients who underwent liver resection of BLR-CLM among 510 patients underwent liver resection for CLM between 2005 and 2013. BLR-CRLM was defined as CRLM of four or more nodules or 5cm or larger nodule. Time to surgical failure (TSF) was defined as the time until unresectable relapse or death. OS, recurrence free survival (RFS) and TSF were compared between BLR-CLM treated with neoadjuvant chemotherapy (NAC) and up-front surgery (US). Results: After median follow-up period of 38 months, 5-year survival rate after liver resection of resectable cases (n = 263), BLR-CLM (n = 169), and initially unresectable CLM (n = 78) are 67.7%, 47.5% and 32.6%, respectively. For patients with BLR-CLM, 22 patients with early recurrence during or early after postoperative chemotherapy for the primary were excluded. In the remaining 147 patients, 75 patients were treated with NAC and 72 with US. Cumulative 5-year overall survival rates, progression free survival rates, and time-to surgical failure in NAC and US group are as follows: OS (60.1% vs 47.7%, p = 0.084), PFS (23.1% vs 15.5%, p < 0.0001), TSF (38.0% vs 34.4%, p = 0.020). Conclusions: Preoperative chemotherapy for BLR-CLM could improve PFS and TSF. The impact on OS was still marginal. Prospective controlled study will be necessary.

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The impact of R1 resection for colorectal liver metastases on local recurrence and overall survival in the era of modern chemotherapy: An analysis of 1,428 resection areas

Surgery ◽

10.1016/j.surg.2018.09.005 ◽

2019 ◽

Vol 165 (4) ◽

pp. 712-720 ◽

Cited By ~ 1

Author(s):

Francesco Ardito ◽

Elena Panettieri ◽

Maria Vellone ◽

Massimo Ferrucci ◽

Alessandro Coppola ◽

...

Keyword(s):

Overall Survival ◽

Local Recurrence ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

R1 Resection ◽

The Impact

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Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival

World Journal of Surgical Oncology ◽

10.1186/1477-7819-12-127 ◽

2014 ◽

Vol 12 (1) ◽

pp. 127 ◽

Cited By ~ 30

Author(s):

Jon-Helge Angelsen ◽

Arild Horn ◽

Geir Eide ◽

Asgaut Viste

Keyword(s):

Overall Survival ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Resection Margins ◽

The Impact

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High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.6132 ◽

2011 ◽

Vol 29 (8) ◽

pp. 1083-1090 ◽

Cited By ~ 241

Author(s):

Antoine Brouquet ◽

Eddie K. Abdalla ◽

Scott Kopetz ◽

Christopher R. Garrett ◽

Michael J. Overman ◽

...

Keyword(s):

Survival Rate ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Complete Resection ◽

Colorectal Metastases ◽

Medical Group ◽

Two Stage ◽

Second Stage ◽

Mean Size ◽

The Impact

Purpose Prolonged survival after two-stage resection (TSR) of advanced colorectal liver metastases (CLM) may be the result of selection of best responders to chemotherapy. The impact of complete resection in this well-selected group is controversial. Patients and Methods Data on 890 patients undergoing resection and 879 patients who received only chemotherapy for CLM were collected prospectively. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR. Additionally, we evaluated a cohort of nonsurgically treated patients selected to mirror the TSR population: colorectal metastases with liver-only disease, objective response to chemotherapy, and alive 1 year after chemotherapy initiation. Results Sixty-five patients underwent the first stage of TSR; 62 patients fulfilled the inclusion criteria for the medical group. TSR patients had a mean of 6.7 ± 3.4 CLM with mean size of 4.5 ± 3.1 cm. Nonsurgical patients had a mean of 5.9 ± 2.9 CLM with mean size of 5.4 ± 3.4 cm (not significant). Forty-seven TSR patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the TSR group and 15% in the medical group (P = .005). In patients who underwent TSR, noncompletion of TSR and major postoperative complications were independently associated with worse survival. Conclusion TSR is associated with excellent outcome in patients with advanced CLM as a result of both selection by chemotherapy and complete resection of metastatic disease.

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EP.TH.140Enhanced Recovery in Liver Surgery: Effect on Survival in Patients with Colorectal Liver Metastases

British Journal of Surgery ◽

10.1093/bjs/znab309.021 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Irena Stefanova ◽

Eirini Martinou ◽

Rajesh Kumar ◽

Angela Riga ◽

Tim Worthington ◽

...

Keyword(s):

Overall Survival ◽

Liver Resection ◽

Liver Metastases ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Postoperative Outcomes ◽

Short Term ◽

Increased Risk ◽

Eras Protocol ◽

The Impact

Abstract Aims Enhanced recovery after surgery (ERAS) has shown to reduce perioperative stress and improve short-term postoperative outcomes. However, little is known regarding the effect of ERAS on long-term oncological outcomes. This study aimed to investigate the impact of ERAS on overall survival in patients undergoing liver resection for colorectal liver metastases (CRLM). Methods Between 2006 and 2014, 387 patients underwent liver resection for CRLM at Royal Surrey County Hospital. The ERAS protocol after liver surgery was implemented in 2011. Data regarding patients’ demographics, oncological characteristics, long and short-term postoperative outcomes were obtained from a prospectively maintained institutional database. Comparative analysis was performed between the ERAS and non-ERAS patients. The primary objective was overall survival (OS) and secondary objective included identification of factors affecting OS. Results The groups were similar in terms of demographics, primary and secondary disease oncological characteristics. Intrahepatic recurrence rates were comparable between ERAS and non-ERAS group (30.3% vs 27% p = 0.496). Patients in the ERAS group demonstrated better 3-year survival rates in comparison with the non-ERAS ones (78.2% vs 68%, p = 0.027). Although survival was better at 5-years as well, this did not reach statistical significance (54.2% vs 50%, p = 0.470). The Cox proportional hazards analysis showed that increased length of hospital stay (HR 1.338, 95% CI 1.039-1.723, p = 0.024) and operative time (HR 1.580, 95% CI 1.173-2.128, p = 0.003) were the only parameters associated with increased risk for worse OS. Conclusions ERAS protocol may be associated with improved 3-year survival in patients undergoing liver surgery for CRLM.

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Two-stage hepatectomy for colorectal liver metastases: A multi-institutional retrospective review.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.351 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 351-351

Author(s):

Nicholas G Berger ◽

Bradford Kim ◽

Sepideh Gholami ◽

Georgios A Margonis ◽

Cecilia Ethun ◽

...

Keyword(s):

Overall Survival ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Recurrence Free Survival ◽

Short Term ◽

Two Stage ◽

Liver Remnant ◽

Free Survival ◽

Second Stage ◽

Major Complications

351 Background: A significant number of patients with colorectal liver metastases (CRLM) present with unresectable bilobar disease. Two-stage hepatectomy with portal vein embolization (PVE) have been described as a treatment for CRLM allowing for volume regeneration of a functional liver remnant. No large-scale multi-institutional studies exist. The aim of this project was to describe outcomes following two-stage hepatectomy, including overall survival (OS), recurrence-free survival (RFS), and complications. Methods: Patients completing two-stage hepatectomy for CRLM at five US institutions were identified and retrospectively analyzed (2000-2015). Overall survival and recurrence-free survival following second-stage surgery, short-term mortality, Clavien-Dindo complications, and readmission rates were examined. Results: A total of 209 patients were identified. Mean age was 52 (SD +/-11.4), 59.8% were male, and 87.0% had synchronous disease. A total of 65.1% of patients underwent PVE, and 27.3% underwent hepatic artery infusion pump placement. 88.3% of cases underwent neoadjuvant chemotherapy. Following the first stage, 30-day morbidity was 24.4%, with 4.8% major (Clavien-Dindo grade ≥3) complications, and 30-day readmission was 6.7%. Mean time between first and second stage was 4.1 months (S.D. +/-3.1), and 57.5% received systemic chemotherapy between the two resections. Following the second stage, overall complications were 47.4% with 23.9% major complications, and 30-day readmission was 9.7%. Mortality following second stage was 3.8% at 30 days, and 5.3% at 90-days. Following the second stage, RFS at 1-, 3-, and 5-years was 80%, 46%, and 29% respectively. OS at 1-, 3-, and 5-years was 87%, 64%, and 45% respectively. Conclusions: Two-stage hepatectomy for CRLM provides acceptable recurrence-free and overall survival in the context of advanced bilobar disease. Major complications and readmission following the first stage are rare. Following the second stage, short-term major morbidity, mortality, and readmissions are also acceptable. For well-selected patients, two-stage hepatectomy remains a safe and effective treatment for CRLM, with potential for more widespread adoption.

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